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General NPI Number Information
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NPI Number | 1972099604
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Entity Type | Organization
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Legal Business Name | BLACK DOG HOME CARE, LLC
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 8700 CROWNHILL BLVD STE 706
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1132
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Country | US
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Telephone | 210-308-9346
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Fax | 210-308-9352
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Provider Business Mailing Address
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Address Line | 8700 CROWNHILL BLVD STE 706
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1132
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Country | US
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Telephone | 210-308-9346
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Fax | 210-308-9352
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Authorized Official
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Title or Position | PRESIDENT
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Name | SLOANE COLLEEN WENDELL
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Credential |
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Telephone | 210-308-9342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 018533
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License Number State | TX
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